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Published in: Chinese Neurosurgical Journal 1/2019

Open Access 01-12-2019 | Epidural Hematoma | Research

Risk factors for bad outcome in pediatric epidural hematomas: a systemic review

Authors: Peter Spazzapan, Klemen Krašovec, Tomaž Velnar

Published in: Chinese Neurosurgical Journal | Issue 1/2019

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Abstract

Background

Pediatric epidural hematomas (EDH) represent a neurosurgical emergency. Both surgical and conservative treatment can lead to a good clinical outcome. The aim of the study was to review our series of pediatric EDH and to determine the clinical and radiologic factors, which can influence the final outcome.

Methods

All children aged from 0 to 16 that have been treated between 2013 and 2017 for cranial EDH have been selected.

Results

Thirty children have been included in the study. Seventeen cases have been treated with surgical evacuation and 13 conservatively. Six months after the trauma, the outcome was excellent (mRS 0) in 25/30 (83.3%) cases, mild deficits (mRS 1–2) were present in 4/30 (13.3%), and severe deficits (mRS 3–5) in 1/30 (3.3%) cases. Only a GCS (Glasgow Coma Scale) below 8 at admission was significantly related to the presence of a neurologic deficit at 6 months (p = 0.048).

Conclusions

EDH can be managed with excellent outcomes. Even in the presence of bad initial clinical and radiologic conditions, a correct treatment strategy can lead to a good recovery. In our series, only a GCS below 8 at admission was significantly related to the presence of neurological sequelae.
Literature
1.
go back to reference Ammirati M, Tomita T. Posterior fossa epidural hematoma during childhood. Neurosurgery. 1984;14:541–4.CrossRef Ammirati M, Tomita T. Posterior fossa epidural hematoma during childhood. Neurosurgery. 1984;14:541–4.CrossRef
2.
go back to reference Carcassonne M, Choux M, Grisoli F. Extradural hematomas in infants. J Pediatr Surg. 1977;12:69–73.CrossRef Carcassonne M, Choux M, Grisoli F. Extradural hematomas in infants. J Pediatr Surg. 1977;12:69–73.CrossRef
3.
go back to reference dos Santos AL, Plese JP, Ciquini Júnior O, Shu EB, Manreza LA, Marino Júnior R. Extradural hematomas in children. Pediatr Neurosurg. 1994;21:50–4.CrossRef dos Santos AL, Plese JP, Ciquini Júnior O, Shu EB, Manreza LA, Marino Júnior R. Extradural hematomas in children. Pediatr Neurosurg. 1994;21:50–4.CrossRef
4.
go back to reference Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg. 1968;29:1–12.CrossRef Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg. 1968;29:1–12.CrossRef
5.
go back to reference Mazza C, Pasqualin A, Feriotti G, Da Pian R. Traumatic extradural haematomas in children: experience with 62 cases. Acta Neurochir. 1982;65:67–80.CrossRef Mazza C, Pasqualin A, Feriotti G, Da Pian R. Traumatic extradural haematomas in children: experience with 62 cases. Acta Neurochir. 1982;65:67–80.CrossRef
6.
go back to reference Parslow RC, Morris KP, Tasker RC, Forsyth RJ, Hawley CA. Epidemiology of traumatic brain injury in children receiving intensive care in the UK. UK Paediatric Traumatic Brain Injury Study Steering Group; Paediatric Intensive Care Society Study Group. Arch Dis Child 2005;90:1182–1187. Parslow RC, Morris KP, Tasker RC, Forsyth RJ, Hawley CA. Epidemiology of traumatic brain injury in children receiving intensive care in the UK. UK Paediatric Traumatic Brain Injury Study Steering Group; Paediatric Intensive Care Society Study Group. Arch Dis Child 2005;90:1182–1187.
7.
go back to reference Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst. 2006;22:363–7.CrossRef Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst. 2006;22:363–7.CrossRef
8.
go back to reference Ersahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst. 1993;9:96–9.CrossRef Ersahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst. 1993;9:96–9.CrossRef
9.
go back to reference Gerlach R, Dittrich S, Schneider W, Ackermann H, Seifert V, Kieslich M. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care. 2009;25:164–9.CrossRef Gerlach R, Dittrich S, Schneider W, Ackermann H, Seifert V, Kieslich M. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care. 2009;25:164–9.CrossRef
10.
go back to reference Paiva WS, Andrade AF, Mathias Júnior L, Guirado VM, Amorim RL, Magrini NN, Teixeira MJ. Management of supratentorial epidural hematoma in children: report on 49 patients. Arq Neuropsiquiatr. 2010;68:888–92.CrossRef Paiva WS, Andrade AF, Mathias Júnior L, Guirado VM, Amorim RL, Magrini NN, Teixeira MJ. Management of supratentorial epidural hematoma in children: report on 49 patients. Arq Neuropsiquiatr. 2010;68:888–92.CrossRef
11.
go back to reference Pasaoglu A, Orhon C, Koc K, Selcuklu A, Akdemir H, Uzunoglu H. Traumatic extradural haematomas in pediatric age group. Acta Neurochir. 1990;106:136–9.CrossRef Pasaoglu A, Orhon C, Koc K, Selcuklu A, Akdemir H, Uzunoglu H. Traumatic extradural haematomas in pediatric age group. Acta Neurochir. 1990;106:136–9.CrossRef
12.
go back to reference Cook RJ, Dorsch NW, Fearnside MR, Chaseling R. Outcome prediction in extradural haematomas. Acta Neurochir. 1988;95:90–4.CrossRef Cook RJ, Dorsch NW, Fearnside MR, Chaseling R. Outcome prediction in extradural haematomas. Acta Neurochir. 1988;95:90–4.CrossRef
13.
go back to reference Stieg PE, Kase CS. Intracranial hemorrhage: diagnosis and emergency management. Neurol Clin. 1998;16:373–90.CrossRef Stieg PE, Kase CS. Intracranial hemorrhage: diagnosis and emergency management. Neurol Clin. 1998;16:373–90.CrossRef
14.
go back to reference Ben Abraham R, Lahat E, Sheinman G, Feldman Z, Barzilai A, Harel R, Barzilay Z, Paret G. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas. Pediatr Neurosurg. 2000;33:70–5.CrossRef Ben Abraham R, Lahat E, Sheinman G, Feldman Z, Barzilai A, Harel R, Barzilay Z, Paret G. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas. Pediatr Neurosurg. 2000;33:70–5.CrossRef
15.
go back to reference Bejjani GK, Donahue DJ, Rasin J, Broemeling LD. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg. 1997;25:302–8.CrossRef Bejjani GK, Donahue DJ, Rasin J, Broemeling LD. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg. 1997;25:302–8.CrossRef
16.
go back to reference Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, Lin TK. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery. 1993;32:176–9.CrossRef Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, Lin TK. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery. 1993;32:176–9.CrossRef
17.
go back to reference Beni-Adani L, Flores I, Spektor S, Umansky F, Constantini S. Epidural hematoma in infants: a different entity? J Trauma Acute Care Surg. 1999;46:306–11.CrossRef Beni-Adani L, Flores I, Spektor S, Umansky F, Constantini S. Epidural hematoma in infants: a different entity? J Trauma Acute Care Surg. 1999;46:306–11.CrossRef
18.
go back to reference Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(Suppl 3):7–15. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(Suppl 3):7–15.
19.
go back to reference Knuckey NW, Gelbard S, Epstein MH. The management of “asymptomatic” epidural hematomas. J Neurosurg. 1989;70:392–6.CrossRef Knuckey NW, Gelbard S, Epstein MH. The management of “asymptomatic” epidural hematomas. J Neurosurg. 1989;70:392–6.CrossRef
20.
go back to reference Ciurea AV, Kapsalaki EZ, Coman TC, Roberts JL, Robinson JS 3rd, Tascu A, Brehar F, Fountas KN. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst. 2007;23:335–41.CrossRef Ciurea AV, Kapsalaki EZ, Coman TC, Roberts JL, Robinson JS 3rd, Tascu A, Brehar F, Fountas KN. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst. 2007;23:335–41.CrossRef
21.
go back to reference Bruce DA. Head injuries in the pediatric population. Curr Probl Pediatr. 1990;20:61–107.PubMed Bruce DA. Head injuries in the pediatric population. Curr Probl Pediatr. 1990;20:61–107.PubMed
22.
go back to reference Rocchi G, Caroli E, Raco A, Salvati M, Delfini R. Traumatic epidural hematoma in children. J Child Neurol. 2005;20:569–72.CrossRef Rocchi G, Caroli E, Raco A, Salvati M, Delfini R. Traumatic epidural hematoma in children. J Child Neurol. 2005;20:569–72.CrossRef
23.
go back to reference Browne GJ, Lam LT. Isolated extradural hematoma in children presenting to an emergency department in Australia. Pediatr Emerg Care. 2002;18:86–90.CrossRef Browne GJ, Lam LT. Isolated extradural hematoma in children presenting to an emergency department in Australia. Pediatr Emerg Care. 2002;18:86–90.CrossRef
24.
go back to reference Bor-Seng-Shu E, Aguiar PH, Matushita H, Manreza LA, Ferreira AA. Actual asymptomatic epidural hematomas in childhood. Report of three cases. Childs Nerv Syst. 1997;13:605–7.CrossRef Bor-Seng-Shu E, Aguiar PH, Matushita H, Manreza LA, Ferreira AA. Actual asymptomatic epidural hematomas in childhood. Report of three cases. Childs Nerv Syst. 1997;13:605–7.CrossRef
Metadata
Title
Risk factors for bad outcome in pediatric epidural hematomas: a systemic review
Authors
Peter Spazzapan
Klemen Krašovec
Tomaž Velnar
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Chinese Neurosurgical Journal / Issue 1/2019
Electronic ISSN: 2057-4967
DOI
https://doi.org/10.1186/s41016-019-0167-6

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